Sleep Apnea - DRHC Dubai ENT Clinic DRHC

Make a general examination, looking for any craniofacial abnormalities.

• Listen carefully for stertor while awake, or asleep.
• Watch for mouth breathing.
• Carry out an oral examination, to determine the size of the tonsils.

These can be graded by 2 Methods:

The Brodsky score

1. Tonsils in fossa
2. Tonsils occupy up to 25% of the airway
3. 26% to 50%
4. 51% to 75%
5. more than 75%

The Friedman score

1. No tonsils
2. Tonsil within pillars
3. Tonsil beyond pillars
4. Tonsil extending to the midline
5. Tonsils touching in the midline.

• Examine the nose to establish whether there is coexisting rhinitis and whether there is likely to be adenoid hypertrophy.
• Examine the ears for coexisting otitis media with effusion.
• Look for neck lymphadenopathy

How to confirm the diagnosis of sleep apnea

• Oximetry overnight for observation of the O2 saturation and heart rate
• Polysomnography
• Nasolaryngoscopy
• Imaging for the airway and mandible
• Laboratory tests

How to manage sleep apnea

• Diet and exercise to reduce the bulky tissue around the airway passage
• Medicines for treating adenoids, allergy GERD, etc.
• Adenoidectomy with or without tonsillectomy or tonsillotomy
• Jaw distraction in micrognathia (small mandible) or big tong tongue etc.
• Oral appliance
• Tongue reduction if the tongue is big
• Continuous positive airway pressure (CPAP) may be required in children where treatment is not possible.

Indications for Pediatric Respiratory Investigations

• Diagnosis of OSA unclear or inconsistent
• Age <2 years
• Weight <15 kg
• Down syndrome
• Cerebral palsy
• Hypotonia or neuromuscular disorders
• Craniofacial anomalies
• Mucopolysaccharidosis
• Obesity (BMI >2.5 SDS (standard deviation scores),
• Significant comorbidities such as congenital heart disease,
• chronic lung disease
• Residual symptoms after adenotonsillectomy

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